Provider Demographics
NPI:1588119341
Name:MARYLAND FUNCTIONAL MEDICINE CENTER, INC
Entity type:Organization
Organization Name:MARYLAND FUNCTIONAL MEDICINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-926-4609
Mailing Address - Street 1:7600 OSLER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7705
Mailing Address - Country:US
Mailing Address - Phone:443-488-3321
Mailing Address - Fax:443-252-8085
Practice Address - Street 1:7600 OSLER DR STE 105
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-488-3321
Practice Address - Fax:443-252-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty